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Development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department

BACKGROUND: The increasing demand for acute care and restructuring of hospitals resulting in emergency department (ED) closures and fewer inpatient beds are reasons to improve ED efficiency. The approach towards the patient care process varies among doctors. The objective of this study was to determ...

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Autores principales: Koks, Daisy Roxanna Johanna Christina, Zonderland, Maartje Elisabeth, Heringhaus, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560181/
https://www.ncbi.nlm.nih.gov/pubmed/23317313
http://dx.doi.org/10.1186/1865-1380-6-1
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author Koks, Daisy Roxanna Johanna Christina
Zonderland, Maartje Elisabeth
Heringhaus, Christian
author_facet Koks, Daisy Roxanna Johanna Christina
Zonderland, Maartje Elisabeth
Heringhaus, Christian
author_sort Koks, Daisy Roxanna Johanna Christina
collection PubMed
description BACKGROUND: The increasing demand for acute care and restructuring of hospitals resulting in emergency department (ED) closures and fewer inpatient beds are reasons to improve ED efficiency. The approach towards the patient care process varies among doctors. The objective of this study was to determine variations in the patient care process and patient flow among emergency physicians (EP’s) and internists at the ED of Leiden University Medical Centre (LUMC), the Netherlands. METHODS: An observational instrument was developed during a pilot study at the LUMC ED, following observations of activities performed by EP’s and internists. The instrument divides all different types of activities a clinician can perform on the ED into eight categories. Using the observational instrument, their activities were observed and registered for 10 separate days. Primary outcomes were defined as the time spend on the eight separate activity categories, the total length of stay (LOS) and the number of patients seen during an interval. Secondary outcomes were general observations of working routine features that determine patient flow at the ED. The obtained data were analyzed into SPSS. RESULTS: Ten doctors were observed during a total of ± 36 hours in which 42 patients were seen. Although EP’s were observed for a shorter period of time than internists (13:48 vs. 22:10 hrs, -38%), they saw more patients (26 vs. 16, +62%). EP’s tended to spend a higher proportion of their time on patient contact than internists (27.2% vs. 17.3%, p = 0.06). Both groups dedicated the highest proportion of their time to documentation (31.5% and 33.4%, p = 0.75) and had little communication with ED nurses (3.7% and 2.4% p = 0.57). The average LOS of internal patients was higher than that of EP’s patients (5.25 ± sd 1:33 and 2.26 ± sd 1:32 hours). Internists occupied more treatment rooms at the same time (2.41 vs. 2.08, p < 0.00) and followed a more sequential working routine. CONCLUSIONS: This paper describes the determination of variations in the ED care process and patient flow among EP’s and internists by an observational instrument. A pilot study with the instrument showed variations in the patient care process and patient flow among the two groups at the LUMC ED.
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spelling pubmed-35601812013-01-31 Development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department Koks, Daisy Roxanna Johanna Christina Zonderland, Maartje Elisabeth Heringhaus, Christian Int J Emerg Med Original Research BACKGROUND: The increasing demand for acute care and restructuring of hospitals resulting in emergency department (ED) closures and fewer inpatient beds are reasons to improve ED efficiency. The approach towards the patient care process varies among doctors. The objective of this study was to determine variations in the patient care process and patient flow among emergency physicians (EP’s) and internists at the ED of Leiden University Medical Centre (LUMC), the Netherlands. METHODS: An observational instrument was developed during a pilot study at the LUMC ED, following observations of activities performed by EP’s and internists. The instrument divides all different types of activities a clinician can perform on the ED into eight categories. Using the observational instrument, their activities were observed and registered for 10 separate days. Primary outcomes were defined as the time spend on the eight separate activity categories, the total length of stay (LOS) and the number of patients seen during an interval. Secondary outcomes were general observations of working routine features that determine patient flow at the ED. The obtained data were analyzed into SPSS. RESULTS: Ten doctors were observed during a total of ± 36 hours in which 42 patients were seen. Although EP’s were observed for a shorter period of time than internists (13:48 vs. 22:10 hrs, -38%), they saw more patients (26 vs. 16, +62%). EP’s tended to spend a higher proportion of their time on patient contact than internists (27.2% vs. 17.3%, p = 0.06). Both groups dedicated the highest proportion of their time to documentation (31.5% and 33.4%, p = 0.75) and had little communication with ED nurses (3.7% and 2.4% p = 0.57). The average LOS of internal patients was higher than that of EP’s patients (5.25 ± sd 1:33 and 2.26 ± sd 1:32 hours). Internists occupied more treatment rooms at the same time (2.41 vs. 2.08, p < 0.00) and followed a more sequential working routine. CONCLUSIONS: This paper describes the determination of variations in the ED care process and patient flow among EP’s and internists by an observational instrument. A pilot study with the instrument showed variations in the patient care process and patient flow among the two groups at the LUMC ED. Springer 2013-01-15 /pmc/articles/PMC3560181/ /pubmed/23317313 http://dx.doi.org/10.1186/1865-1380-6-1 Text en Copyright ©2013 Koks et al.; licensee Springer. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Koks, Daisy Roxanna Johanna Christina
Zonderland, Maartje Elisabeth
Heringhaus, Christian
Development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department
title Development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department
title_full Development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department
title_fullStr Development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department
title_full_unstemmed Development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department
title_short Development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department
title_sort development of an observational instrument to determine variations in the patient care process and patient flow among emergency physicians and internists at the emergency department
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560181/
https://www.ncbi.nlm.nih.gov/pubmed/23317313
http://dx.doi.org/10.1186/1865-1380-6-1
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